“I started residency with a lot of motivation, but now I just feel jaded. I hate days off because they end, and I end up legitimately crying before going back to work.
I’m an internal medicine resident, and I realized I hate how medicine is practiced. I love the material and the actual medicine. I just hate how it’s done.
I hate how many hospitalists practice defensive medicine. How doctors are in constant fear of being sued and work with the mentality of “covering our a**es.”
I hate waking up early in the morning only to be yelled at by moody attendings during rounds. I hate how we make minimum wage working 80 hours a week in a profession that costs us more than money. I hate working 6 days a week.
Before people say, “Go see someone,” I legitimately have no time to do anything or see anyone. I’ve considered therapy, but… when?!
How to cope and does it get better? I’m on a roller coaster that I can’t get off of. Can’t imagine doing this for two more years.”
I found this heartbreaking post while researching what to consider if you’re considering quitting residency. Sadly, this resident isn’t alone or even in the minority of residents who are crying out for help.
The numbers clearly show this to be the case. In a survey conducted at 13 residency programs, 58% of residents indicated they were seriously considering leaving training.
The reasons they gave looked like this:
- Sleep deprivation on a specific rotation (50%)
- Undesirable future lifestyle (47%)
- Excessive work hours on a specific rotation (41.4%)
To anyone who has attended medical school, started or completed a residency program, and gone on to work as a physician, this won’t come as a surprise. We’ve all been there or are currently there, struggling to make it through.
I could sidetrack into a rant on how the system must change if we’re to have any hope of dealing with the burnout U.S. doctors and doctors in training report experiencing, but I won’t. While the last years of COVID-19 have pushed the reported rates of burnout to an unprecedented 68%, this number can’t just be blamed on the pandemic.
When it comes to the well-being of residents, I’ll let The Darwinian Doctor speak to the issue in her eloquent way. I think this quote from her writing sums it up well:
“How hypocritical can the system be that it promotes the well-being of patients but completely ignores the well-being of its own workforce?”
To Quit or Not To Quit Residency: 4 Things You Should Know
If you’re one of the 144,660 medical residents (2021 number) and are considering quitting your program, let’s take a look at four helpful things to know before you throw in the towel.
1. How would quitting impact your future medical service options?
2. How would quitting affect how competent a doctor you can be?
3. How will not quitting impact your health and well-being?
4. How will quitting affect your earning potential?
How Would Quitting Impact Your Future Medical Service Options?
In general, residency programs take three to seven years after graduating from medical school. The first year is spent as an intern, and then, depending on your specialty, you can expect to spend an additional two to six years as a resident.
Residents are doctors in training who provide medical services to patients while under the supervision of fully independent doctors. The big question is, can you work as a doctor or in clinical medicine without completing a residency?
The bottom line is that, yes, you can. With limitations and depending on which state you plan to practice.
While some states require physicians to complete a full residency before they can become licensed, many states allow you to become a general practitioner with a medical degree and one year as an intern. One year, not three or seven.
The ultimate goal for many of us assumes we’ll become board-certified and licensed before we start practicing medicine.
To become a licensed doctor, you need to graduate from medical school, receive some level of postgraduate training, and pass an exhaustive national medical licensing exam. In order to practice as a doctor, you will need to have a license.
On the other hand, board certification isn’t always necessary. In order to be board-certified, you need at least a minimum of three years of postgraduate training, again depending on which specialty you want to go into. Once you’ve completed your residency, you’ll need to pass the relevant test in the area of your specialty.
Board certification is associated with specialties and was created at the beginning of the 20th century. Physicians at that time became board-certified only when they were interested in working in narrow niche areas of medicine — specialties.
The key distinction here is completing a residency program. If you plan to be a general practitioner or family doctor, you will need to complete at least one year of an internship (or residency) program.
You may or may not wish to complete an additional year of residency before branching out as a practicing clinician. Whether you complete one or two years of residency, you’ll then need to pass all four United States Medical Licensing Exams.
At that time, you can begin working as a qualified primary care doctor. Depending on the hospital and state, you may not be qualified to join a hospital staff. Most hospitals require doctors to complete a full residency program and specialty certification.
If you plan to develop a medical specialty or subspecialty, you’ll need to buckle down and complete the full residency program associated with your specialty. Some examples of residency lengths are:
- Internal medicine 3 years
- Emergency medicine 3-4 years
- Obstetrics/gynecology 4 years
- Pathology 4 years
- General surgery 5 years
- Orthopedic surgery 5 years
- Plastic surgery 6 years
- Neurosurgery 7 years
How Would Quitting Affect How Competent a Doctor You Can Be?
By now, it’s clear that the purpose of completing a full residency program is to qualify for board certification, and if you aren’t interested in becoming a certified specialist, the extra years you would spend as a resident are truly not necessary.
Once you graduate from med school, you’ve earned your M.D. or D.O. You’ll have spent four years learning from books and lectures and have a brain full of medical knowledge on how to care for patients.
Many med school programs focus the first two years on science training, where you learn about “basic medical concepts, the structure and functions of the body, diseases, diagnoses, and treatment concepts,” along with how to take a medical history and other “essential competencies.”
The last two years of med school include clinical training, where you’ll get hands-on experience with patients in the “major medical specialties.” This time is spent under the supervision of a faculty member, fellow, or resident.
We’ve all heard the formula that says that “more work hours = more experience/learning = better doctors. While it may be true in one sense, there’s a lot wrong with that kind of thinking.
Dr. Kat Lopez shared her experience of resigning from her residency program after her first year and its impact on her journey to practice medicine. She found herself “hopeless, totally discouraged, very, very bored by the type of treadmill medicine I was being trained in and exhausted physically from lack of sleep. I was undernourished…really suffering in the system.”
At the point she considered selling her soul to the pharmaceutical rep industry, she met a powerhouse mentor who helped her realize she already had “all of the emotional intelligence, the educational prowess, the passion, and the drive to truly live my personal dream.”
With her mentor’s support, Kat found work in a collaborative practice. This allowed her to develop a private practice as an independent contractor. Doing the job she dreamed of.
How Will Not Quitting Impact Your Health and Well-being?
When it comes to health and well-being, it’s fairly obvious that no matter what state your health is in before you start a residency program, you will not leave in better shape. A better question is to calculate if you can afford the toll it will take on every part of your life.
It’s fun (especially for non-medical folks) to watch hour-long TV dramas that are based in hospitals and see the shenanigans that happen behind the scenes among the staff. There are crises to manage, lives to save, and medical mysteries to solve, all accomplished while secret and not-so-secret romances blossom and die.
The physical toll on residents’ bodies starts with shift work, short sleep, and physical inactivity. Eating well often goes by the wayside, and residents exist on quick, nutrition-poor meals gobbled down between the next shift and the hope of a few more minutes of sleep.
A study on the “rigors of residency” was done by the Journal of General and Internal Medicine as it related to the effects on both physical and mental health in residents. The subjects were given accelerometry-based fitness-tracking devices (Fitbits®) that gave a real-time appraisal of how much they slept on a daily basis and how much physical activity they got during the same period.
For more than a century, residents have been made to show up in the “pre-dawn hours” so they can update senior residents and attending doctors about patients. This early rising wasn’t compensated by going to bed earlier and resulted in interrupting circadian rhythms and never-ending exhaustion.
And if the physical toll isn’t bad enough, depression was a common companion for many residents. The high stress of hospital environments, feeling professionally and socially isolated, and exposure to medical emergencies and trauma all whittle down residents’ resilience and ability to care for themselves.
It takes an intentional commitment to your own well-being in order to make it through the long years of a residency program, but with the right support, it can be worth it. The top reasons residents decide to stay when they want to leave come down to support — from family, significant others, and other residents, and the perception of being better rested.
How Will Quitting Affect Your Earning Potential?
Many people who decide during their residency training that it would be better for them to quit the program feel they need to stick it out because of their accumulated student debt, which averages around $250,000.
The average resident earns $60,000 annually, depending on what part of the country you’re in. In today’s economy, that may be enough to live on, but it doesn’t provide a lot of extra to pay down student debt.
So, let’s take this apart and see how quitting your residency impacts your debt load. I crunched the numbers, and while these are rough estimates based on average numbers, they may surprise you.
Let’s take three scenarios: Doctor A quits residency after the necessary year of residency and works for an average annual salary of $150,00. Doctor B completes seven years of residency and becomes a specialist in their field, earning an average annual salary of $250,000.
Unarguably, the specialist will, at the end of the day, make more money than the non-specialist, but if you are struggling over whether to quit or continue your residency and your debt load is paralyzing you, you may find this freeing.
In our pretend scenario, both doctors start their residency at 30, owe $250,000 in student loans, make $60,000, and pay down $10,000 of debt during each year of their residency. They then find work and continue to apply ⅙ of their total earnings to pay down their student loans.
Including one year of residency, at the end of 10 years and 7 months, Doctor A has paid off his debt in full. If he retires at 55, earning the same salary of $150,000, he will have earned around $6,360,000.
Including seven years of residency, at the end of 11 years and 3 months, Doctor B has paid off his debt in full. If he retires at 55, earning the same salary of $250,000, he will have earned around $9,320,000.
Even with these very rough estimates, you can see that even a one-year residency can let you pay off your debt and flourish financially.
I’m glad to be able to say that the resident whose story I quoted at the beginning did share this follow-up:
“I’m so overwhelmed by the support I received from everyone. I’ve literally cried your messages. You guys are all amazing. I find myself coming frequently to this during the day to keep myself going. Thank you so much for your kind words and the resources you provided me. Thank you for reaching out.”
This topic cuts to the heart of why I do what I do. My mission and passion are to help you create a business or career that will empower you to take control of the good work you do.
Whether you’re a practicing doctor or a doctor in training, I’d love to hear from you if you can relate to this article and learn about your journey.
